Rectus Diastasis, what we wish celeb trainers knew: Written by Laura Boston (Physiotherapist)
Certain celebrity trainers have recently been in the spotlight for incorrect exercise regimes during pregnancy, and despite being excellent advocates for maintaining health and fitness during and after this stage in a women’s life, it is important to set the records straight that it is a case of do as we say and not what you see in magazines! The physical and mental health benefits of exercise are widespread and relevant at all stages of life; however, there are times where it is important to exercise within guidelines outlined by a health professional. During Pregnancy and following childbirth can be one of these times. For some the changes in their body make them more motivated to exercise than ever and for others these changes can lead to fear and avoidance of exercise. Rectus Diastasis or an increase in the space between the abdominal muscles can contribute to avoidance of exercise.
In fact all women have some level of rectus diastasis in the late stages of pregnancy (Gillard and Brown 1996, Diane Lee 2013) . For many this will resolve in the first 6-8 weeks after delivery. Separation and weakening of the midline connective tissues results in less stability and support across the abdominals. Pelvic floor dysfunction is present in 66% of women with Rectus Diatasis (Spitznagle et al 2007). It is therefore important to avoid exercise and activities which increase intra-abdominal pressure. Increased intra abdominal pressure with insufficient support from soft tissues and muscle activation has been linked to hernia and pelvic organ prolapse.
Early activation of the deep abdominals and pelvic floor muscles during pregnancy and post-birth may assist the healing process and also understanding how to avoid further tummy muscle separation is paramount. For those with a rectus diastasis still present 8 weeks after delivery appropriate exercise may reduce the space but most importantly exercise has a vital role in training the core muscle systems for optimal function and injury prevention.
Why Clinical Pilates is a safe way to exercise with a Rectus Diastasis
Physiotherapists are trained to assess the strength and activation patterns of core muscle groups including Transversus Abdominus and the pelvic floor. In Clinical pilates these areas are incorporated into an exercise program at an appropriate level so as to not increase intra-abdominal pressure. All exercises are monitored to ensure there is no abdominal doming or bulging. Clinical pilates includes supervision from a physiotherapist specialised in recognising optimal and dysfunctional movement patterns with individual exercise programs being created using an extensive knowledge and evidence base. Trained women’s health physiotherapists have the knowledge to guide you to understand activities and practices that can increase rectus diastasis during pregnancy and how to enhance your recovery in the ante-natal period.
Why it’s not all about the gap
Rectus Diastasis is linked to dysfunction and weakness in the core; however, there is not a direct relationship between the size of the space in the abdominal muscles and the level of dysfunction and weakness. It is possible to activate global abdominal muscles and create relative closure of the space without activation of the deep core stability muscles and without creating stability and tension in the midline. It is also possible to activate deep abdominals and create tension across the midline without narrowing the gap. Appropriate recruitment of core muscles in order to support and control load is most significant in optimal function and injury prevention regardless of the size of the Rectus Diastasis.
Why its never too late
Years after the birth of a child, or children, Clinical Pilates may not reduce Rectus Diastasis; however, it can be highly significant in restoring appropriate core muscle activation to prevent back pain, pelvic floor dysfunction and instability. This is relevant for safe exercise, optimal function and preventing later complications. Appropriate exercise is important for the many reasons outlined but also to find a safe, comfortable and enjoyable way to stay healthy and active.
What you can do if you have a Rectus Diastasis
- Seek an assessment from a trained physiotherapist with experience in prescribing exercise for rectus diastasis
- Wear a compression garment for the first 12 weeks post-birth (for example SRC recovery shorts, or a simple tubigrip sized correctly)
- Daily core and pelvic floor exercises
- Continue Exercising
What not to do if you have a Rectus Diastasis
- Uncontrolled abdominal exercises that are too hard for your muscles (eg planks, crunches, V sits, leg lowers and heavy weights)
- If there is doming of separation of your muscles while performing any of the above, it means that exercise is too hard for you and needs to be scaled back
- Straining with lifting, coughing or constipation
- Sitting up from a supine position instead of rolling onto your side first
- Don’t avoid abdominal strengthening, be guided by your physio as to where your strength is currently at and what exercises are appropriate
- Continue rectus abdominis strengthening during the third trimester